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Refugees in Texas Face Hurdles Signing Up for Obamacare Plans

This story is a result of a partnership with the Austin-American Statesman’s Tim Eaton and Kelly West. You can find more at

By the end of March,  all people in the U.S. legally must have health insurance – or pay a tax penalty next year. That includes refugees, who often lack the English skills to understand the ins and outs of the insurance system.

Refugees in Central Texas – including those who moved here from Nepal – are trying to figure it out, often by turning to friends and family.

On a recent Thursday night, a pair of volunteers hunched over a computer as they helped refugee Budhi Magar sign up for a plan on the federally-run insurance marketplace, Magar is a refugee from Bhutan by way of Nepal. 

"They do not know what is Obamacare," says John Monger, a pastor at International Restoration Church and a refugee himself. "It’s really difficult, there are a lot of questions, and sitting there for two hours and majority of them don’t know English. And we’re just five, six people sitting here and just helping them. It’s really difficult." 

Every Thursday, Monger and a handful of church volunteers come to this Austin apartment to help refugees sign up for insurance.

Most refugees get eight months of federally funded health insurance, known as refugee medical assistance, when they first get to the U.S. But they don’t always understand what they need to do when that insurance runs out.

"When refugees come to Texas, they are referred to a number of refugee assistance programs," says Linda Gockel Edwards, a spokesperson for the Texas Health and Human Services Commission. She says refugee resettlement organizations in Texas are prepared to communicate with their clients.

"They also contract with translators in many different languages because in Texas we average about 7,800 refugees a year, speaking 65 different languages," Edwards adds.

Bishnu Bastola says he and his family have often heard about what he calls “Obamacare” through TV. Bastola is a 22-year old Nepali refugee who lives with his parents and siblings in Pflugerville.

"We didn’t have no health insurance back in Nepal so it is kind of new for us to have one here," Bastola says. "The hard part it is to know about it, you know what I mean? To know the details. But after all, it is a good thing to have."

No matter their language, refugees need to know that if they don’t get insured in 2014, they’ll pay a tax penalty in 2015 – just like everyone else in the U.S. lawfully.

"You’re talking about really vulnerable populations who live paycheck to paycheck, and I just can’t imagine them being penalized for that," says Kay Mailander, a caseworker with Refugee Services of Texas. She’s also a certified application counselor who can help her clients navigate "But it exists and it’s important that we’re clear to people that come to this country, this is what you have to do now." 

Mailander says one of the most basic challenges is just getting refugees to understand the purpose of health insurance.

"It’s really not until they have an emergency and they have hospital bills that they understand," she adds.

Lu Zeidan, a refugee program coordinator with Interfaith Action of Central Texas, worries that after the eight months of initial medical assistance runs out, many refugees will fall through the cracks. That's because many will earn too much to qualify for Medicaid, but too little to qualify for a tax subsidy through the federally run marketplace.

"The biggest majority of refugees who've been here over a year, they're not in contact with any of the agencies who work with refugees," Zeidan says. "And so they're not going to get the information, and they don't know enough English to access that information. They don't have enough American friends to inform them necessarily of this. And with Texas not expanding Medicaid, we know that a lot of refugees are going to fall into that hole where they’re not eligible for anything. And those are the people who need it most."

Cristina Alaniz, a resettlement case manager with Caritas of Austin, says she's worked with clients who arrive to Texas with urgent medical needs: "Child births, premature labor, hernias, diabetic situations – I think there was some sort of skin poisoning from someone crossing the jungle in Central America," she says. "I also saw urgent care for stomach viruses – situations like those." 

But in Pflugerville, the Bastola family says the difficulty of navigating the world of health insurance in the U.S. is worth it.

"It’s not a problem, it's not a problem. It is good for us," Bishnu Bastola says. "We didn’t have this kind of thing in Nepal, because Nepal is a poor country, first of all. And we’re grateful to have this kind of opportunity."

Bastola says after living 18 years in a refugee camp, this is a challenge they’ll overcome. 

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